WHO, Geneva
26 March 2001

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Global Meeting of WHO Representatives and Liaison Officers

WHO Representatives,

Liaison Officers,

Regional Directors,

Directors of Programme Management,

Colleagues,

I am glad to see you all here in Geneva.

The country operations of the World Health Organization are a vital aspect of our work. They are critical to the success of all efforts to bring about equitable improvements in people's health. I would like to be confident that national governments, civil society, private entities and other development partners recognize that WHO's advice and endorsement are essential for all their health work.

The Regional Directors and I do want to be sure that the regional and Geneva offices of WHO provide optimal support to the country teams, so that they are best able to perform their vital tasks, and are seen to do them well.

The WHO's country operations are the focus of our work together this week. All of WHO’s Country Representatives and Liaison Officers are meeting with colleagues from regional offices and headquarters to work out together how best to make WHO's country operations more effective. It is a real opportunity and we must all make sure that we use it well.

Colleagues,

During the two years since our first WRs meeting a great deal has changed.

Our joint efforts to increase international attention to health issues have paid off. Heads of State from all nations have made it clear that their people cannot participate fully in social and economic development if they are ill. They have put health in a central place on the international development agenda. They have called on us in the WHO to help them respond - to the deep and damaging effects of HIV infection, to the sustained destruction to life caused by tobacco use, to the threats - both perceived and real - of unsafe food, and to the continuing loss of life caused by unsafe pregnancy and maternal mortality. They ask for our analysis of the issues, for our scientific assessments, and for our participation in the response. They ask us to help them take forward intergovernmental mechanisms that can better address tobacco threats, implement health regulations or tackle unsafe food.

Health is now firmly on the agenda in different high level political groupings - such as the Organization for African Unity, the Non-Aligned Movement, ASEAN, the European Union or the G8. Good health is being talked about as being fundamental to human development. It is seen as a key to prosperity.

Health was a central theme in the UN General Assembly Special Session on Social Development, in June 2000, and then at the Millennium Summit in September. Heads of State have committed themselves and their countries to national and global health targets, and to action that will improve health outcomes among all at risk, in order to improve people's capacity to earn and learn, to produce, and to contribute to human security.

There has been an initial political focus within the G8 and the European Union on reducing mortality from HIV/AIDS, TB and malaria: this is rapidly turning into a proper emphasis on building better functioning health systems, on strengthening capacity for public health action, and on the cross-sectoral promotion of health outcomes through action in other sectors.

I have been working hard to secure increased funding for international health action over the next ten years. Early signs are promising, but I know there will be a lag period between talk of - and even pledges of - new money on the one hand, and the funds arriving. Much of this new money will be available as grants, but we should not discourage the use of low interest loans provided on IDA terms by the World Bank and Regional Development Banks, especially when grant funds are used to multiply the funds available.

Some of the increased public attention is linked to enabling those who need care for HIV infection to access it at a price they can afford. The focus has been on bringing down the prices of anti-retroviral medicines: this is important, and maintains a strong public debate. But we all know that the fundamental challenge is to build up health systems so that they bring benefits to those who need them, and to enable countries to locate the human and financial resources for these systems to work. We know too that even though prices have fallen rapidly, these drugs are still beyond what can be afforded by many low income countries. Wider access will also require additional financing. We also need to be sure that this new emphasis on care is linked to greater efforts for preventing infection.

These new developments have created a very different climate for our work. It is perceived as more important than ever before: no longer is it only the Health Ministers that seek WHO's advice and guidance. Prime Ministers, Presidents, Finance Ministers and even Trade Ministers are becoming more concerned with health issues in their countries.

This higher standing brings increased responsibilities and new challenges. The demands on all of us in WHO, and on other parts of the UN family, have grown substantially over the past years. We are expected to respond - working together with governments and other UN partners.

There are key principles that underlie the work we all do - wherever we do it:

• The evidence base: Policies and actions for health should be guided by the best available evidence;
• The need to scale up what works: We need to make sure that people can access the tried and tested health; interventions they need, and improve the performance of health systems in making these interventions available;
• The importance of reaching out: We have to move beyond our own Organization and work well with others who share the same values;
• The focus on poverty: We must always remember the challenges faced by poor people and those who serve them;
• The need to work as one: Our ability to make a difference increases greatly if different parts of WHO work as a coherent whole.

These principles have implications for all of our work.

• Governments and other agencies expect us to have a sound understanding of health sector issues; but they also expect us to appreciate the political and institutional context in which they have to be addressed;
• We are always expected to be a reliable source of high quality advice; but we are also expected to use our technical authority to bring others together so that they agree to the best course of action in any circumstance;
• We are expected to apply the most up-to-date knowledge, setting relevant and realistic standards; but we are also expected to modify this guidance so that it reflects what the people of our Member States actually need.

We are asked to serve, more and more, as advocates and negotiators for better health. This means reconciling the concerns of Member States with those of the external agencies that support health and economic development; taking account of the interests of the private sector, of NGOs and Civil Society, and of professional associations. Increasingly, we are asked to help shape the ways in which governments, external agencies and the private sector work together for health, and to use our own limited funds in ways that make the best difference within that context.

Occasionally, we find it hard to get agreed ways of working between WHO, other parts of the UN system, development banks, bilateral donors or NGOs. If others refuse to come to the table, we cannot give this as an excuse for lack of coherence - even if we are sure that it is not our fault. We have to try even harder, and look for all possible ways to succeed. If there is a real problem, the Regional Director, or one of the Executive Directors may be able to help.

Within WHO we have worked hard to find ways that better enable us all to respond to these kinds of demands.

We have sought a stronger evidence base for analysing the working of the world's health systems. We want to help them to improve the ways in which they work. We have looked hard at the overall purpose of health systems and at ways for assessing their performance.

As many of you will know, the Executive Board discussed WHO's work in this area. I have proposed further consultations on the methods and data sources, together with a peer review of the approach, and a group to advise me on how to take this work forward. This was adopted in an EB resolution. We must sustain ongoing work as these consultations and reviews take place, so that all concerned have as much information as possible for their deliberations.

The Roll Back Malaria and Stop TB partnerships have enabled us to bring a range of partners together, at country level, under the direction of national governments. The global partnerships have helped the partners establish consistent strategies and strong advocacy platforms.

Within these partnerships, WHO is readily accepted as the convenor of technical agencies - particularly at country level. WHO is also valued as a provider of technical guidance, and as best positioned to monitor progress. This means WHO continues to maintain excellent links with research groups and national programmes in malaria, TB and other topical health fields. The challenge, at all times, is to ensure that global, regional and country-level elements of the partnerships function in harmony. WHO country teams are playing a key role in ensuring that this happens, and in helping partners to work together effectively.

Our country teams have had a critical role to play in catalysing country action to reduce the level and consequences of tobacco use. We have all worked together to ensure that countries understand the rationale for the Framework Convention on Tobacco Control, and have encouraged consistent positions between the different parts of government with an interest in this issue.

We have also worked together to establish a stronger and more focused WHO contribution to the global, as well as national and community responses to HIV infection. We are now better able to support this with a strong new WHO-wide approach to HIV/AIDS action, convened by the new department in Geneva, with the strongest possible involvement from my Office.

We have worked together to help countries to access the resources available to them for scaling up their vaccination work. Within the context of GAVI there has been real and tangible progress. We must sustain it, ensuring that the national interagency coordination committees can do their work well. At the same time, we have worked together to sustaining political commitment for polio eradication, and in ensuring that the work moves forward - particularly in unstable settings. Polio eradication is a vital global priority and we must not reduce the effort just because the end may be in sight.

The underlying principles, and the emerging patterns of our work, are expressed in WHO's corporate strategy. This helps us to make sense of what we have to do and the way in which we will do it.

You are all familiar with the four strategic directions in the Corporate Strategy:

1. To reduce the excess mortality of poor and marginalized populations.
2. To effectively deal with the leading risk factors for ill health.
3. To strengthen health systems so that they are effective, responsive and fair.
4. To ensure that development policies in all sectors contribute optimally to better health.

These directions permeate our new General Programme of Work, our daily priority setting and not least our budget. They help those who finance our work see how it fits together. They help all of us as we plan what we do, and assess the results obtained.

Indeed, the corporate strategy is at the heart of the 2002-2003 budget. We have used a new process to prepare it. One that involved regions and headquarters together from the start. One that provides expected results for the whole Organization. One that has enabled the global budget document to be reviewed for the first time by the Regional Committees. In itself it has helped to unite the Organization.

WHO's budget now focuses on programming for 35 areas of work. For each area of work, a set of desired international goals have been identified - often restating goals set by Member States in international conferences or the World Health Assembly. The budget document then details what WHO intends to do within each work area to contribute to the fulfilment of these goals. Expected results, and indicators of achievement, are proposed.

Creating this budget has been a new experience for all of us. We have been learning while doing it. I believe we now have a better tool to achieve results, and to demonstrate to others what we aim to deliver and what we have achieved.

As you know, the process of preparing the country programmes has now been brought closer to the time of their implementation. As we move into detailed operational planning for the next biennium there is a need to discuss strategies and priorities with national authorities. We will be going over this subject in detail tomorrow, but there is one issue that I would wish to share with you now.

When I wrote last year to Regional Directors giving guidance on the preparation of the budget proposals, I said that, in too many countries, WHO’s activities were spread over too many dispersed areas and programmes. This limits and fragments the impact of our contribution. It also makes it harder to manage given this large number of smaller programmes.

For the country programming in 2002-2003, I would therefore wish to see a clearer focus of our work by limiting the number of programme activities in each country. This week I would like you to think about how the WHO country budget can better be used to help countries and other partners achieve the 11 priority areas defined in the strategic budget. How can we be more strategic in the ways in which we use WHO's resources?

Colleagues,

As you are well aware, one of my primary objectives has been to strengthen our corporate performance at country level.

For this we need, as a minimum, a clear description of WHO's strategy, providing the umbrella within which all country work takes place. We also need to encourage closer collaboration among different parts of the Organization in addressing new challenges. One tool to promote this, the Country Cooperation Strategy, provides a medium-term framework, developed to a three to five-year time perspective.

The Country Cooperation Strategy will be discussed in detail this week. It is based on principles that need to guide WHO's work in and with countries. We need to move towards greater internal coherence, and to become more responsive to country needs; to be more selective and shift to fewer priorities; to put more emphasis on our role as policy adviser, broker and convenor; to broaden and develop partnerships at country level and work with other development agencies in a complementary fashion, based on our comparative advantage.

This week, we have a good opportunity to listen to each other, to learn from each other's experiences, to share the realities of working in different country situations and to discuss how we can best work together to take forward priority actions for world health. We want to see countries achieving sustained results from their investments in health, with good use of both national and international resources, and benefits that lead to greater well-being and prosperity for communities and nations.

We in WHO have such an important role to play. And others expect us to fulfil that role, too. The challenge is not easy. A WHO country representative is expected to be a policy adviser, a diplomat, a manager and a public health advocate. As an adviser, the WR often has to present hard truths no-one wants to hear. Unlike many of the other agencies that are involved in health, we do not have the leverage of large amounts of aid. The only reason why governments should heed our advice is its high quality.

I have seen the extraordinary impact of WHO country teams' work at country level. This is both impressive and encouraging. WHO really helps others to make a big difference.

I have heard and seen how national and local level health officials - in Côte D'Ivoire, India, Iran, Pakistan, Nigeria, the Russian Federation, Indonesia, East Timor or Mozambique - rely on WHO country teams for sound, up-to-date advice and guidance.

I have experienced how diverse and challenging your work day can be, and the difficult circumstances under which many of you work.

Most of all, I have shared your enthusiasm in actually seeing results. It is good to be reminded what health outcomes actually mean in practice. I also share your sense of frustration and disappointment when things do not go so well.

Let’s face it. Some times we in Headquarters have not made your work easier. When we launched the World health Report last year, with its ground-breaking new ranking of health systems performance, insufficient information and too short a notice put many of you in a difficult position. We are aware of the problems and have learnt from them.

Of course, our country teams can only be effective if given the tools and the right environment to do the job. It is our collective responsibility to provide you with the requisite back-up and support to undertake this challenging role. That is why I believe, we are not in for a quick fix. We work together, at the level of the country offices, on how best to be more effective. We must, though, assess how best to support country efforts through work at Geneva and regional levels.

I want to be sure that we maintain a wide, open and intense dialogue between all parts of the Organization. When in doubt we must communicate even more. If we are unsure that a message has got through, it must be sent again! The WHO country team must always know what other parts of the network are planning for, or doing with, "their" country.

Colleagues,

As I said earlier, there has recently been unprecedented public attention around the issue of access to care for those living with HIV. This has been an fascinating process where public pressure, media attention, political will, market forces and collaboration between UN agencies and the pharmaceutical companies have worked together to achieve some extraordinary results. The sharp reduction in prices for some anti-retroviral medicines and diagnostics has opened up a much wider arena. We are now moving fast towards achieving a break-through on a fundamental principle of public health: the supply of essential medicines on the basis of need rather than on the ability to pay.

The World Health and World Trade Organizations have together called a meeting in two week's time, in Norway. Representatives from pharmaceutical companies, some governments, academia and civil society will meet to discuss how differential pricing of vital medicines can function in practice. No decisions can be made at this meeting, but I expect that we will prepare the ground for a more systematic approach to reduced medicine prices in poor countries within months, rather than years.

This intensified focus on medicines and care for major illness in poor countries will put new demands on all of us. The legal boundaries of patent rights need to be better clarified, through joint working between the relevant international and national organizations. The ability of governments to set and follow quality criteria for new medicines will be put to the test. And, as I already said, the increased demand for care that these newly available medicines bring with them will pose strong challenges for health system capacity and financing.

This is anything but business as usual. What we are talking about is a massive new challenge for the health sector in poor countries.

There is a need for as much as a five-hundred fold increase in the total effort to help prevent HIV infection, in availability of HIV testing and access to care for those infected. We need to see a thirty to fifty-fold increase in the intensity of preventive measures and access to treatment for malaria and tuberculosis. We also need to scale up the global effort to immunize children, to tackle child, maternal and reproductive ill health, and to combat the effects of noncommunicable diseases.

There is an increasing convergence of concern and positive desire for results - from governments, private corporations, voluntary organizations and research groups. This makes it possible for the WHO to define a framework for action which involves all the major actors.

The purpose of this action is the sustained and equitable improvement in health outcomes within the communities that make up the poorest 30% - 40% of the world's population. This will be achieved through reducing the impact of priority diseases, and their contribution to increased poverty. Effective health action will contribute directly to both human and economic development.

Our task is to ensure that actions taken by the different parties involved yield measurable results. We must find a way to enable many different actors to take forward - in a coherent way - proposals for intensifying health sector action in poor communities being developed by intergovernmental, UN system, NGO and private groups.

We are talking about at least 10 years of intensified action. The initial focus is on infectious diseases, starting with HIV, malaria and TB, but extending to childhood illnesses, nutritional disorders and noncommunicable diseases, including those caused by tobacco.

I would like you to keep this in mind throughout this week’s discussions. The scaling up will stand central in today’s discussion on the role of country teams in global health initiatives and challenges. But it will also permeate the other issues we will discuss over the coming days. Our support for scaling up health action will certainly mean a review of means through which support is provided for international health action, and of the role of country teams within this. For example, have we got the balance of people and skills right?

I will be closely following the meeting's proceedings. Although the Regional Directors and I will be away for two days, at the opening of WHO's new offices in Cairo, I will return to be with you on Friday.

Colleagues,

A growing part of our work is being carried out in emergency situations. Many of you carry out your work in more or less permanent disaster zones. Some of you have been thrown into calamities, such as the recent earthquakes in India and El Salvador.

WHO has an important function to perform before, during and after emergencies. Our role is to assist nations with accurate assessments of damage and needs. It is to ensure the best possible coordination of agencies involved, and to make sure that long-term health perspectives are built into the emergency relief, so that money spent on an emergency can benefit long-term development needs. And afterwards, we in WHO need to help countries share their experiences.

I very much look forward to your insights and your ideas in how to bring our work in emergencies forward.

And, as you all know, the theme for this year’s World Health Day and World Health Report is Mental Health.

Our advocacy efforts will concentrate on reducing stigma associated with mental ill health and on raising awareness about the many effective, affordable treatments that are available but underused, both in developing and industrialized countries.

I will mark the World Health Day twice this year; first in Nairobi on the fourth of April, as the Administrative Committee on Coordination of the UN meets there, hosted by UNEP, and then again here in this room on 6 April, in what we hope will be a warm and forceful celebration of the benefits of inclusion and care.

The World Health Report will give a comprehensive review of what we know: about the current and future global burden of mental ill health and neurological disorders; about the effectiveness of prevention and the availability and restraints to treatment; and about the policies needed to ensure that stigma and discrimination are broken down and effective prevention and treatment are put in place and funded.

I hope our efforts this year will take mental health a large step forward towards equal priority and respect with physical aspects of health.

Colleagues,

I see this meeting as one of the most important events for WHO this year. We come together at a time when we have a chance to make an enormous difference through the work we do in and with countries. The meeting will help us to find better ways to work together, sharing ideas, experiences and strategies, and strengthening our bonds of friendship. I have some specific expectations of what will come out of this meeting - concrete strategies for building up our country teams, for WHO working as one, and for improving our management systems and IT. I welcome your comments on specific issues like emergency health action, staff development and travel policy.

So, as we go into this meeting, please let us work together and contribute to the future effectiveness of the whole of WHO. By all means, express your immediate concerns about factors that affect how you can work. At the same time, please look ahead, putting your country experiences into a regional and global context.

I believe that the development of our work in countries is at the centre of WHO's mission over the next decade. It is also a critical contribution to sustained and equitable health outcomes within countries and regions, and to the secure future of our world.

Thank you.